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Gupta R, Gaines C, Ginty C. Leg Pain-An Unexpected Twist. J Emerg Med 2024; 67:e442-e445. [PMID: 39237442 DOI: 10.1016/j.jemermed.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/15/2024] [Accepted: 07/30/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Obturator hernia is a rare condition, often presenting with non-specific symptoms, such as thigh pain, groin pain, nausea, or vomiting. Obturator hernias are most common in thin, elderly women. Oftentimes, they are diagnosed late in the disease course resulting in complications and high morbidity and mortality. CASE REPORT We present the case of a 75-year-old female who presented with right thigh pain with no other symptoms. After computed tomography (CT) of the abdomen/pelvis, the patient was found to have an incarcerated obturator hernia complicated by a small bowel obstruction, ultimately requiring urgent surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the very general symptoms associated with the condition, the diagnosis of obturator hernia can easily be missed, leading to a delayed diagnosis, more complications, and a higher morbidity and mortality rate. Due to the risk associated with a delayed diagnosis, it is important for emergency physicians to maintain a high clinical suspicion for the diagnosis.
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Affiliation(s)
- Rahul Gupta
- Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey.
| | - Cameron Gaines
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Catherine Ginty
- Department of Emergency Medicine, Cooper University Hospital, Camden, New Jersey
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2
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Nguyen HQ, Dang TK, Tran HT, Phan HL, Ho DKD. Multiple Complicated Concurrent Hernias in a Single Patient: A Case Report. Cureus 2024; 16:e56582. [PMID: 38646287 PMCID: PMC11031192 DOI: 10.7759/cureus.56582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple complicated concurrent hernias with obturator hernia and paraesophageal hernia unusually occur in clinical settings. The obturator hernias belong to a rare pelvic hernia that accounts for a minority of all abdominal hernias. Besides, paraesophageal hernias occur commonly in elderly female patients. Clinical manifestations of these hernias are usually unspecific and the diagnosis is based on computed tomography (CT). In this paper, we presented a case of multiple complicated hernias in an 81-year-old woman. She was admitted to our hospital due to intestinal obstruction that was caused by a simultaneous obturator and paraesophageal hernia. She was successfully treated by laparoscopic hernia repair. Postoperative progression was favorable. She was then discharged from the hospital after four hospital days.
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Affiliation(s)
- Huy Q Nguyen
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Toan K Dang
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Hien T Tran
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Huy L Phan
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Dang Khoa D Ho
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
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3
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Kano Y. Posterior branch-type obturator hernia: a rare cause of hip pain. BMJ Case Rep 2023; 16:e258674. [PMID: 38123317 DOI: 10.1136/bcr-2023-258674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Yasuhiro Kano
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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4
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Velumani Y, Kumar N, Singh K, Naik MM, Basu S. Intestinal Obstruction Due to an Incarcerated Obturator Hernia: A Case Report and Review of the Literature. Cureus 2023; 15:e51382. [PMID: 38292986 PMCID: PMC10825814 DOI: 10.7759/cureus.51382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
An obturator hernia (OH) is a rare form of pelvic hernia in which the abdominal contents protrude through the obturator canal. Malnourished, frail, and multiparous elderly females are at risk of an OH. Preoperative diagnosis of obturator hernia is challenging because of non-specific symptoms. Most of the cases of OH reported in the literature are diagnosed during a laparotomy for acute intestinal obstruction. However, a contrast-enhanced computed tomography (CECT) scan of the abdomen is the best diagnostic investigation for OH. The morbidity and mortality are high because of the associated complications. We report a case of an obturator hernia in a 79-year-old cachectic female with features of acute intestinal obstruction and the usefulness of a CT scan in the preoperative diagnosis. Early diagnosis and treatment are the keys to preventing disastrous complications.
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Affiliation(s)
- Yogapriya Velumani
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Navin Kumar
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Karamveer Singh
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - M Murali Naik
- Radiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Somprakas Basu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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5
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Li H, Cao X, Kong L. Case report: Obturator hernia: Diagnosis and surgical treatment. Front Surg 2023; 10:1159246. [PMID: 37181602 PMCID: PMC10167930 DOI: 10.3389/fsurg.2023.1159246] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/23/2023] [Indexed: 05/16/2023] Open
Abstract
Background Obturator hernia (OH) is a rare external abdominal hernia, accounting for only 0.07%-1% of all hernia cases. Because the female pelvis is wider and there is less preperitoneal adipose tissue, the obturator canal is larger, which can lead to herniation of abdominal contents when abdominal pressure increases in elderly women with thin body. The clinical symptoms of patients with obturator hernia included abdominal pain, nausea, vomiting, etc., and the mass in the inguinal region could not be touched. The positive Howship-Romberg sign is a specific sign of OH. CT is the first choice for the diagnosis of obturator hernia. Since intestinal incarceration in OH patients is prone to lead to intestinal necrosis, emergency surgical treatment is often required. However, due to the lack of specificity of its clinical manifestations, the misdiagnosis rate is high, which often leads to the delay of diagnosis and treatment. Methods We report the case of an 86-year-old woman with a thin body and a history of multiple deliveries. The patient presented with abdominal pain, bloating, and constipation for 5 days. Physical examination revealed a positive Howship-Romberg sign on the right side, and CT examination suggested intestinal obstruction. Therefore, an urgent exploratory laparotomy was performed. Results After opening the abdominal cavity we found that the wall of the ileum was embedded in the right obturator, and the proximal bowel was significantly dilated. We restored the embedded bowel wall to its original position, resected the necrotic bowel and performed an end-to-end anastomosis of the small intestine. The right hernia orifice was sutured, and OH was diagnosed during the operation. Conclusion This article summarizes the diagnosis and treatment of OH by sharing this case, so as to provide a more detailed plan for early diagnosis and treatment of OH.
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Affiliation(s)
- Han Li
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo, China
- Binzhou Medical University, Binzhou, China
| | - Xuefeng Cao
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Lingqun Kong
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou, China
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6
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Kumar A, Mehdi K. Laparoscopic management of obturator hernia in the setting of intestinal obstruction: A report of two cases and review of literature. Med J Armed Forces India 2023; 79:113-116. [PMID: 36605339 PMCID: PMC9807685 DOI: 10.1016/j.mjafi.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023] Open
Abstract
Owing to its rarity and non-specific clinical features, a diagnosis of obturator hernia is often delayed until the patient presents with intestinal obstruction. Often the diagnosis is made on a Computed Tomography (CT) scan or during exploratory laparotomy. While a laparoscopic approach is well described in an elective scenario, open surgery through a midline laparotomy has been the preferred approach for obturator hernia with intestinal obstruction. However, a few cases of obstructed obturator hernia have been reported that have been managed laparoscopically. We present our experience of two elderly patients who presented with intestinal obstruction. A CT scan helped clinch the diagnosis of obturator hernia as the cause and both were managed laparoscopically.
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Affiliation(s)
- Ameet Kumar
- Senior Advisor (Surgery) & GI Surgeon, 5 Air Force Hospital, Jorhat, India
| | - K.M. Mehdi
- Graded Specialist (Surgery), 5 Air Force Hospital, Jorhat, India
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7
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Garcia EM, Pietryga JA, Kim DH, Fowler KJ, Chang KJ, Kambadakone AR, Korngold EK, Liu PS, Marin D, Moreno CC, Panait L, Santillan CS, Weinstein S, Wright CL, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022; 19:S329-S340. [PMID: 36436960 DOI: 10.1016/j.jacr.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Board Member, Taubman Museum of Art.
| | - Jason A Pietryga
- Division Chief, Emergency Radiology at UNC Chapel Hill, Chapel Hill North Carolina; and University of Alabama at Birmingham, Birmingham, Alabama
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; and Vice-Chair of Education, University of Wisconsin Department of Radiology
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; Chair ACR LI-RADS; Division Chief, SAR Portfolio Director, RSNA Radiology Senior Deputy Editor
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Section Chief of Abdominal Imaging, Director of MRI, Chair of Committee on C-RADS
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital and Medical Director, Martha's Vineyard Hospital Imaging
| | - Elena K Korngold
- Section Chief, Body Imaging/Chair, Department of Radiology Promotion and Tenure Committee; Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Lucian Panait
- President, Minnesota Hernia Center, Minneapolis, Minnesota; American College of Surgeons; American Hernia Society (member of the Technology and Value Assessment Committee); Practice Advisory Committee Member, American Hernia Society
| | - Cynthia S Santillan
- Vice-Chair of Clinical Operations, Department of Radiology, University of California San Diego, San Diego, California
| | | | | | - Jennifer Zreloff
- Georgia, Primary Care Physician, Emory University, Atlanta, Georiga; Medical Director, Seavey General Medicine Clinic; Assistant Director of Innovation Seavey Comprehensive Internal Medicine Clinic, Emory University, Atlanta, Georgia
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Section Chief Abdominal Imaging, Director of MRI and CT
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8
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Uehara H, Kameyama H, Iwaya A, Yamazaki T, Ishii S, Tomizawa G, Takamatsu Y, Gohda Y, Enoki Y, Sudo N, Katada T, Kobayashi K, Sato D, Yokoyama N, Kuwabara S, Otani T. Laparoscopic transabdominal preperitoneal hernioplasty for bilateral obturator hernias and left inguinal hernia with emaciation caused by anorexia nervosa: A case report. Asian J Endosc Surg 2022; 15:629-632. [PMID: 35052013 DOI: 10.1111/ases.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
A 55-year-old woman receiving treatment for anorexia nervosa presented with abdominal pain and right thigh pain. Her body mass index was 12.9 kg/m2 . Computed tomography showed fluid storage in the distal side of the right obturator foramen and revealed a dilated small bowel without a starting point of obstruction. We diagnosed a naturally reduced incarcerated right obturator hernia and performed elective surgery with a laparoscopic approach for hernia repair the next day. Intraperitoneal observation revealed bilateral obturator hernias and a left direct-type inguinal hernia. Transabdominal preperitoneal hernioplasty was performed using two self-gripping polyester meshes for bilateral obturator hernia repair and a lightweight 3D-shaped mesh for left inguinal hernia repair. Women with emaciation caused by anorexia nervosa may be more likely to have complex hernias, including obturator hernia, and laparoscopic approaches may be useful for preoperatively diagnosed nonstrangulated obturator hernias.
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Affiliation(s)
- Hiroaki Uehara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hitoshi Kameyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Iwaya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshiyuki Yamazaki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shota Ishii
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Gen Tomizawa
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Yuki Takamatsu
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Yousuke Gohda
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Yuya Enoki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Natsuru Sudo
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Tomohiro Katada
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Kazuaki Kobayashi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Daisuke Sato
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Naoyuki Yokoyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Tetsuya Otani
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
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9
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Yamaguchi K, Kitamura M, Hashiguchi J, Harada T, Funakoshi S, Eguchi S, Mukae H, Nishino T. Two cases of obturator hernia in patients undergoing hemodialysis: case report and literature review. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obturator hernia (OH) is an extremely rare abdominal wall hernia with risk factors including aging, female sex, emaciation, and increased abdominal pressure. Its symptoms are nonspecific, and diagnosis is often delayed; however, this delay can lead to a fatal course. Therefore, early diagnosis and surgical intervention are necessary to reduce the mortality rate associated with OH. Considering the risk factors for OH, patients currently undergoing hemodialysis (HD) may be particularly vulnerable to OH. Here, we report two cases of OH in patients undergoing HD along with a review of the relevant literature.
Case presentation
Case 1 included a 76-year-old female undergoing HD due to autosomal dominant polycystic kidney disease. She was hospitalized for upper abdominal pain, vomiting, and diarrhea. On the day of hospitalization, she was diagnosed with OH using computed tomography and underwent emergency surgery. Case 2 included a 90-year-old emaciated female who was admitted to our hospital for projectile vomiting while undergoing HD. She was diagnosed with OH and shock, but surgery was not performed due to shock. Nonetheless, her blood pressure gradually increased, and she completely recovered. Spontaneous reduction in OH was confirmed on the third day of hospitalization. Both patients recovered well.
Conclusions
The symptoms of OH are non-specific, and certain symptoms such as vomiting and anorexia are often overlooked because they are common in patients undergoing HD. It is important to include OH in the differential diagnosis of digestive organ symptoms in patients undergoing HD, especially in those with risk factors for OH, such as elderly female patients on HD due to autosomal dominant polycystic kidney disease.
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Yamagishi S, Aramaki O, Yoshida N, Mitsuka Y, Kawai T, Yamazaki S, Kang W, Nakayama H, Moriguchi M, Higaki T, Kochi M, Okamura Y. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac035. [PMID: 35145631 PMCID: PMC8826419 DOI: 10.1093/jscr/rjac035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shunsuke Yamagishi
- Correspondence address. Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo 173-8610, Japan. Tel: +81-3-3972-8111; Fax: +81-3-3957-8299; E-mail:
| | - Osamu Aramaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yoshida
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mitsuka
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takaharu Kawai
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shintaro Yamazaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Woodae Kang
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsugu Kochi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yukiyasu Okamura
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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Diab J, Badiani S, Berney CR. A decade review of emergency obturator hernia repairs. ANZ J Surg 2021; 91:1596-1603. [PMID: 34125472 DOI: 10.1111/ans.17011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Obturator hernia is a rare pelvic hernia associated with a high morbidity and mortality. It most commonly occurs in elderly, multiparous females with symptoms and signs of small bowel obstruction. We present an Australian hospital network experience on emergency presentations of obturator hernias highlighting differences between clinical profile and surgical management. METHODS A retrospective review of adult patients diagnosed with acute obturator hernia during a 10 year period (2010-2020) was conducted across 10 major Sydney hospitals in New South Wales, Australia. RESULTS Obturator hernia was diagnosed in 18 patients (mean 82.7 years, range: 60-96 years old), all confirmed on pre-operative computed tomography imaging. The most common presentations were elderly women demonstrating clinical features of a small bowel obstruction. The mean onset of symptoms from home to hospital admission was 49.4 h. Non-survivors had a significantly elevated urea level (15.6 vs. 7.8 mmol/L, p = 0.036) at presentation and a longer delay from onset of presenting symptoms to diagnosis (84.0 vs. 36.2 h, p = 0.028). Eleven patients underwent urgent laparotomy and six laparoscopic repairs. The mean operative time was 101.0 min. The average hospital length of stay was 16.2 days with a mortality rate of 27.8%. CONCLUSION Timely diagnosis and operative intervention for obturator hernia is the cornerstone of management.
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Affiliation(s)
- Jason Diab
- Bankstown Lidcombe Hospital, Bankstown, New South Wales, Australia.,University of Notre Dame, School of Medicine, Sydney, New South Wales, Australia.,University of New South Wales, School of Medicine, Sydney, New South Wales, Australia
| | - Sarit Badiani
- Bankstown Lidcombe Hospital, Bankstown, New South Wales, Australia.,University of New South Wales, School of Medicine, Sydney, New South Wales, Australia
| | - Christophe R Berney
- Bankstown Lidcombe Hospital, Bankstown, New South Wales, Australia.,University of New South Wales, School of Medicine, Sydney, New South Wales, Australia
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12
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Li Z, Gu C, Wei M, Yuan X, Wang Z. Diagnosis and treatment of obturator hernia: retrospective analysis of 86 clinical cases at a single institution. BMC Surg 2021; 21:124. [PMID: 33750366 PMCID: PMC7941974 DOI: 10.1186/s12893-021-01125-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background To explore the clinical characteristics, diagnosis and treatment of obturator hernia. Methods Eighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed. Results Thirty days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients (24/59, 40.7%). There were 4 deaths (4/59, 6.8%) in this group, all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3-year recurrence rates of 5.1% (3/59) and 7.1% (1/14) were observed in the emergency surgery and the elective surgery group, respectively. Conclusions CT examination plays an important role in improving the diagnostic rate of obturator hernia. Timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, intestinal resection and postoperative complications may be the important factors leading to postoperative death.
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Affiliation(s)
- Zhengzheng Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Xing Yuan
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
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13
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Hayes C, Schmidt K, Neduchelyn Y, Ivanovski I. Obturator hernia of Richter type: a diagnostic dilemma. BMJ Case Rep 2020; 13:13/12/e238252. [PMID: 33372018 PMCID: PMC7772305 DOI: 10.1136/bcr-2020-238252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
An 85-year-old malnourished woman presented with symptoms of small bowel obstruction of uncertain aetiology. She had presented numerous times over the previous 2 years with symptoms of left groin and thigh pain, vomiting and abdominal distension. A CT of her abdomen and pelvis ultimately revealed a left-sided pelvic hernia, between the obturator internus and pectineal muscles. This was consistent with an obturator hernia. Diagnostic laparoscopy confirmed an obturator hernia of Richter type, incarcerated within the left obturator canal. Reduction revealed a hernia sac containing viable small bowel. A primary repair was performed using a double-layer suture technique to both close and plug the hernia defect. The patient rapidly recovered following hernia repair, with resolution of all previous long-standing symptoms. This case exemplifies the typical presentation of an obturator hernia and the diagnostic challenge it poses to clinicians.
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Affiliation(s)
- Cathal Hayes
- General Surgery, Wexford General Hospital, Wexford, Ireland
| | - Karl Schmidt
- General Surgery, Wexford General Hospital, Wexford, Ireland
| | | | - Ivan Ivanovski
- General Surgery, Wexford General Hospital, Wexford, Ireland
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14
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Herath M, Kanhere H. Loin to groin pain -A case report of an intermittent obturator hernia mimicking ureteric colic. Int J Surg Case Rep 2019; 66:356-359. [PMID: 31927400 PMCID: PMC6956747 DOI: 10.1016/j.ijscr.2019.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Obturator hernia is a rare condition and can cause significant diagnostic challenges due to a lack of reliable clinical examination signs. Presentations can have a variety of features and it is a diagnosis that needs to be considered - especially in elderly multiparous women. PRESENTATION OF CASE We present a 76-year-old female who has multiple presentations to the Emergency Department (ED) with transient episodes of severe loin to groin pain. Imaging Computer Tomography (CT) initially demonstrated a mild left hydronephrosis and she underwent an unremarkable ureteroscopy and stenting. Following stent removal she continued to have recurrent episodes of the pain. She presented to the ED with one such episode. A repeat CT scan was performed and this demonstrated an obturator hernia with partial small bowel obstruction. She underwent a laparoscopy by which time the hernia had reduced and her pain had settled. Laparoscopy revealed bilateral obturator herniae with the one on left larger than the right. Both were repaired laparoscopically and she made an uneventful recovery. DISCUSSION Obturator hernia is an uncommon condition and can have a varied presentation. Comprehensive review of literature demonstrates the difficulty in making accurate diagnosis. Open intervention was the initial gold standard of treatment but there is a growing body of evidence advocating for the use of laparoscopy in an emergency setting. CONCLUSION Early diagnostic imaging with CT while a patient is symptomatic can aid in making an accurate diagnosis. Laparoscopic repair can be safely used with good outcome in the context of an incarcerated obturator hernia.
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Affiliation(s)
- Matheesha Herath
- Port Augusta Hospital, 71 Hospital Road Port Augusta, South Australia, 5700, Australia; The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia.
| | - Harsh Kanhere
- Port Augusta Hospital, 71 Hospital Road Port Augusta, South Australia, 5700, Australia; The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia; The Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia, Australia
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The role of computed tomography in the diagnosis of rare pelvic hernias on the example of strangulated hernia of the obturator canal: review. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10391-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Obturator hernia is a rare form of pelvic hernia that is more common in older women. The clinical diagnosis of hernia is difficult. This type of hernia cannot be visualized by a general examination, and it is also impossible to reveal it by palpation, that is why it is more often detected at the stage of complications and is accompanied by high mortality. This work presents observation of a strangulated hernia of the obturator canal in a 96-year-old patient diagnosed with computed tomography.
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Joe C, Gowda V, Koganti S. Laparoscopic assisted repair of strangulated obturator hernia-Way to go. Int J Surg Case Rep 2019; 61:246-249. [PMID: 31387073 PMCID: PMC6695249 DOI: 10.1016/j.ijscr.2019.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/27/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
Heightened awareness and understanding of Obturator Hernias is important. Delays in diagnosis and treatment increase Morbidity and Mortality. Laparoscopic techniques of repair are met with increasing success in both elective and an emergency setting.
Introduction Obturator hernias are a rare subtype of intra-abdominal hernias that present with considerable challenges in both diagnosis and surgical repair. Delays in diagnosis and management significantly increases the Morbidity and Mortality. Presentation of case An elderly 70-year-old female presented with Lower abdominal pain radiating to the medial side of the left leg over a year that has become persistent and continuous over the 3 day period. Patient was found to have a Richter's type of strangulated obturator hernia on diagnostic laparoscopy. A laparoscopic assisted resection of the strangulated small bowel and repair of the Hernia was performed. Postoperatively patient had an uneventful recovery. Discussion Surgical treatment is the standard of care for an obturator Hernia. Increasing number of laparoscopic repairs are being performed in the recent past. Minilaparotomy greatly facilitates the resection and anastomosis of a dead bowel without jeopardizing cosmesis and mesh placement at the time of repair. Conclusion Heightened awareness of the condition combined with our proposition of a Hybrid repair achieves optimal results in an emergency setting. A Laparoscopic assisted repair of a strangulated hernia provides a durable repair and at the same time offers the patient benefits of minimally invasive surgery.
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Affiliation(s)
- Casey Joe
- Department of Surgery, Bronx-Care Health System, Icahn School of Medicine at Mount Sinai, Milstein 4A, 1650 Selwyn Avenue, New York, 10457, USA
| | - Vinayak Gowda
- Department of Surgery, Bronx-Care Health System, Icahn School of Medicine at Mount Sinai, Milstein 4A, 1650 Selwyn Avenue, New York, 10457, USA
| | - Suman Koganti
- Department of Surgery, Bronx-Care Health System, Icahn School of Medicine at Mount Sinai, Milstein 4A, 1650 Selwyn Avenue, New York, 10457, USA.
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17
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Ramkumar J, Lu D, Scott T. Laparoscopic Mesh Repair of Bilateral Obturator Hernias Post-Peritoneal Dialysis. Perit Dial Int 2019; 39:95-97. [PMID: 30692236 DOI: 10.3747/pdi.2018.00203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abdominal wall hernias are prevalent in patients undergoing peritoneal dialysis (PD). Obturator hernias, first described by Arnaud de Ronsil in 1724, are an uncommon type of hernia where intra-abdominal contents protrude through the obturator foramen. The following case highlights a rare presentation of bilateral obturator hernias with right femoral and inguinal hernia in an 82-year-old woman post-PD. This patient presented with 5 months of bilateral thigh pain and swelling and was found to only have a right-sided obturator hernia on computer tomography (CT) scan. Intraoperatively, bilateral obturator hernias were found along with right inguinal and femoral hernias, which were all repaired laparoscopically with polypropylene mesh. Postoperatively, the patient developed a self-limiting port site hematoma and resumed PD 1 month post-surgery. Due to the high morbidity and mortality from obturator hernias, prompt diagnosis and treatment are imperative. Compared with open hernia repair, laparoscopic hernia repairs are associated with quicker return to usual activities and less persisting pain and numbness. This case portrays that laparoscopic approach to bilateral obturator hernias can be considered in patients post-PD.
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Affiliation(s)
- Jonathan Ramkumar
- University of British Columbia, Division of General Surgery, Vancouver, BC, Canada
| | - Daphne Lu
- University of British Columbia, Division of General Surgery, Vancouver, BC, Canada
| | - Tracy Scott
- St. Paul's Hospital, Department of General Surgery, Vancouver, BC, Canada
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18
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Memon ZA, Aisha M, Qadar LT, Ochani RK, Ali Asghar S. Rare Case of Peritonitis due to Ileal Perforation Secondary to Richter's Type of Obturator Hernia. Cureus 2019; 11:e4289. [PMID: 31183270 PMCID: PMC6538228 DOI: 10.7759/cureus.4289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Obturator hernia is an extremely rare condition accounting for almost 0.07%-1% of all abdominal wall hernias, usually occurring in the elderly and emaciated females with a history of previous abdominal surgery. The symptoms of this particular hernia are non-specific; therefore, a high index of clinical suspicion should always be made. This rare condition may lead to acute small intestinal obstruction. The pre-operative diagnosis is challenging and often misleading on occasions, especially in co-morbid cases. This leads to delayed diagnosis and surgical intervention, hence causing an increased morbidity and mortality rate. The computed tomography (CT) scan of the abdomen and pelvis is the gold standard for diagnosis. We present a case of an 80-year-old female, with known comorbid of hypertension, initially diagnosed as peritonitis and on further examination revealed strangulated obturator hernia with proximal perforation, that underwent lower midline laparotomy with resection of necrotic bowel, an end-to-end anastomosis, and repair of the defect by vicryl suture.
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Affiliation(s)
| | - Maria Aisha
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Suresh A, Chinnakkulam Kandhasamy S, Sahoo AK, Amaranathan A, Vishnu Prasad NR. A Masquerading and Unconventional Cause of Dynamic Intestinal Obstruction: Strangulated Obturator Hernia. Cureus 2018; 10:e2124. [PMID: 29607272 PMCID: PMC5875977 DOI: 10.7759/cureus.2124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Obturator hernia is an extremely rare type of abdominal wall hernia occurring mostly in elderly, thin females. It is characterized by the herniation of intra-abdominal contents through the obturator foramen. Symptoms are often nonspecific, and the patient usually presents with an acute or subacute intestinal obstruction. A high index of suspicion is needed in such females presenting with abdominal distention and positive Howship-Romberg signs. Computed tomography of the abdomen and pelvis are often necessary to arrive at a diagnosis, and immediate surgical intervention is recommended. The high postoperative morbidity and mortality are often attributed to a delay in the diagnosis and in initiating treatment. We present a case of a 65-year-old lady with strangulated obturator hernia who underwent emergent, lower midline laparotomy with resection and anastomosis of the small bowel and purse-string repair of the hernial defect.
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Affiliation(s)
- Aneesh Suresh
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Ashok Kumar Sahoo
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anandhi Amaranathan
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - N R Vishnu Prasad
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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20
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Abstract
A 70 year old lady presented to surgery emergency with small bowel obstruction without any obvious etiology. On exploration she was found to have an obstructed obturator hernia, which is a rare pelvic hernia with an incidence of 0.07-1.4% of all intra-abdominal hernias. Diagnosis is often delayed until laparotomy for bowel obstruction. Strangulation is frequent and mortality remains high (25%). Early diagnosis and surgical treatment contributes greatly to reduce the mortality and morbidity rates. A variety of techniques have been described, however surgical repair has not been standardized. It is an important diagnosis to be considered in elderly patients with intestinal obstruction.
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Affiliation(s)
- S Shreshtha
- Department of General Surgery, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India
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21
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Xue H, Fu Y, Cui LG. Small Bowel Obstruction Secondary to Obturator Hernia Preoperatively Diagnosed by Ultrasound. Chin Med J (Engl) 2016; 129:490-1. [PMID: 26879027 PMCID: PMC4800854 DOI: 10.4103/0366-6999.176078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
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22
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A rare cause of acute mechanical intestinal obstruction: a strangulated obturator hernia. North Clin Istanb 2015; 2:69-72. [PMID: 28058344 PMCID: PMC5175055 DOI: 10.14744/nci.2015.46855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/18/2014] [Indexed: 11/21/2022] Open
Abstract
Obturator hernia is a rarely-seen type of abdominopelvic hernia. It is generally seen in thinner, old, multipara patients. The most frequently seen clinical sign is intestinal obstruction associated with strangulation. Diagnosis is generally made during operation in patients brought into emergency room because of intestinal obstruction. Delay in diagnosis in older patients results in higher rates of morbidity and mortality. Herein, we present a 68-year-old multipara patient who consulted to the emergency service with clinical manifestations of intestinal obstruction, and who was operated with the preoperative diagnosis of “strangulated obturator hernia” established by means of computed-tomography.
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Seppälä TT, Tuuliranta M. Coexisting ipsilateral right femoral hernia and incarcerated obturator hernia. BMJ Case Rep 2015; 2015:bcr-2014-208361. [PMID: 25716157 DOI: 10.1136/bcr-2014-208361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Obturator hernia (OH) is an uncommon cause of bowel obstruction and described in elderly females in the literature. The treatment has traditionally been laparotomy because of an acute nature of the condition. However, because of old age and comorbidities that OH is associated with, general anaesthesia may need to be avoided. In the current case, a transinguinal preperitoneal approach and management are presented after delayed preoperative diagnosis of bowel obstruction caused by a coexisting right incarcerated OH and ipsilateral non-reducible femoral hernia. A 91-year-old woman had a 6-day history of nausea and vomiting. She was referred to surgery because of persisting vomiting, but without any abdominal pain. A CT scan showed a hernia in the right groin area but the diagnosis was delayed. The hernias were repaired using a preperitoneal transinguinal approach. Bowel resection was not needed. The obturator canal and the femoral ring were both covered by a Bard Polysoft patch.
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Affiliation(s)
- Toni T Seppälä
- Department of Gastroenterologic Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Mikko Tuuliranta
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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24
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Ramser M, Messmer AS, Zbinden I, Von Holzen U, Nebiker CA. Incarcerated obturator hernia-laparoscopic repair with intraoperative view of the corona mortis. J Surg Case Rep 2014; 2014:rju081. [PMID: 25157088 PMCID: PMC4142338 DOI: 10.1093/jscr/rju081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Obturator hernias are a rare form of abdominal wall hernias. We present a case of a patient with an obturator hernia diagnosed by the classical signs of lower abdominal pain, a positive Howship–Romberg sign (painful internal rotation of the hip) and a computed tomography scan showing a herniated loop of small bowel. During the emergency laparoscopic hernia repair (transabdominal preperitoneal approach) a variant vessel, the corona mortis, was detected.
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Affiliation(s)
- Michaela Ramser
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
| | - Anna Sarah Messmer
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Isabella Zbinden
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Urs Von Holzen
- Department of General Surgery, University Hospital Basel, Basel, Switzerland
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Tokushima M, Aihara H, Tago M, Tomonaga M, Sakanishi Y, Yoshioka T, Hyakutake M, Kyoraku I, Sugioka T, Yamashita SI. Obturator hernia: A diagnostic challenge. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:280-3. [PMID: 25006359 PMCID: PMC4085114 DOI: 10.12659/ajcr.890555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/14/2014] [Indexed: 11/29/2022]
Abstract
PATIENT Female, 90 FINAL DIAGNOSIS: Obturator hernia Symptoms: Epigastric pain • vomiting MEDICATION - Clinical Procedure: - Specialty: Gastroenterology and Hepatology. OBJECTIVE Challenging differential diagnosis. BACKGROUND Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare. CASE REPORT We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment. CONCLUSIONS Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT.
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Affiliation(s)
- Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga City, Japan
- The Community Center of General Medicine, Saga University Hospital, Saga City, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Motosuke Tomonaga
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Yuta Sakanishi
- The Community Center of General Medicine, Saga University Hospital, Saga City, Japan
| | - Tsuneaki Yoshioka
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Masaki Hyakutake
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Itaru Kyoraku
- Department of General Medicine, Saga University Hospital, Saga City, Japan
| | - Takashi Sugioka
- The Community Center of General Medicine, Saga University Hospital, Saga City, Japan
| | - Shu-ichi Yamashita
- Department of General Medicine, Saga University Hospital, Saga City, Japan
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Togawa Y, Muronoi T, Kawaguchi H, Chiku T, Sano W, Hashiba T, Ueda A, Kaneoya K. Minimal incision transinguinal repair for incarcerated obturator hernia. Hernia 2014; 18:407-11. [PMID: 23644742 DOI: 10.1007/s10029-013-1095-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with incarcerated obturator hernia are usually elderly, frail, and physically inactive women with serious comorbidities. Although a laparotomy is standard surgical intervention for emergency incarcerated or strangulated obturator hernia, it is invasive particularly for these high-risk patients. The aim of this study is to show the feasibility of minimum open inguinal approach to reduce surgical risk for preoperatively diagnosed incarcerated obturator hernia. METHODS Between April 2008 and July 2012, 3 consecutive incarcerated obturator hernia patients at Kamitsuga General Hospital who were diagnosed preoperatively by computed tomography underwent the following procedure. First a 4 cm inguinal hernia incision and preperitoneal dissection through the opening of the deep inguinal ring are made. The obturator hernia can be easily found 2 cm dorsally from the Cooper's ligament extraperitoneally. A small incision is made at medial sharp edge of the hernia defect. The hernia sac and its content can then be reduced. If the incarcerated bowel is viable, a prosthetic mesh is placed as a patch. If the bowel is necrotic, the damaged bowel loop is withdrawn through the wound and easily reconstructed extra-abdominally. RESULTS All operations were successfully completed with this procedure. All patients recovered without incident. CONCLUSIONS Minimal incision transinguinal repair for diagnosed incarcerated obturator hernia is feasible and provides an improved option to more invasive procedures.
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Affiliation(s)
- Y Togawa
- Department of Surgery, Kamitsuga General Hospital, 1-1033 Shimota-cho, Kanuma, Tochigi, Japan,
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Tee CL, Evans T, Ratnayake S, Strekozov B. Small bowel obstruction secondary to bilateral obturator hernia: a rare occurrence. J Surg Case Rep 2014; 2014:rju009. [PMID: 24876374 PMCID: PMC4164190 DOI: 10.1093/jscr/rju009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Obturator hernia (OH) is a rare type of pelvic hernia. It can cause significant morbidity and mortality, especially in the elderly age group. Delayed treatment is associated with high rates of strangulation (25-100%). We present an 88-year-old woman who presented with symptoms of bowel obstruction and right hip pain. Computed tomography (CT) abdomen revealed bilateral OHs and bowel obstruction secondary to the right OH. She was managed conservatively due to her age and co-morbidities and her bowel obstruction subsequently resolved. She was discharged, only to re-present 1 month later with similar complaints. A repeat CT scan revealed bilateral OHs and bowel obstruction due to the left OH. She underwent midline laparatomy and both OHs were reduced. The right OH was fixed with polypropylene mesh plug and the left OH was fixed with primary closure. The patient recovered and no recurrence was noted during follow-up.
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Affiliation(s)
- Chin Li Tee
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
| | - Tobias Evans
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
| | - Sujith Ratnayake
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
| | - Boris Strekozov
- Department of Surgery, Caboolture Hospital, Caboolture, QLD, Australia
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29
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Killeen S, Buckley C, Smolerak S, Winter DC. Small bowel obstruction secondary to right obturator hernia. Surgery 2013; 157:168. [PMID: 23891477 DOI: 10.1016/j.surg.2013.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/28/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Shane Killeen
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland.
| | - Christina Buckley
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Sebastian Smolerak
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Desmond C Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
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30
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Leow JJ, How KY, Goh MH, Woon WWL, Low JK. Non-operative management of obturator hernia in an elderly female. Hernia 2013; 18:431-3. [PMID: 23299115 DOI: 10.1007/s10029-012-1036-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/27/2012] [Indexed: 11/30/2022]
Abstract
Obturator hernia is a rare surgical condition, with about 800 cases being reported in the literature. It can cause significant morbidity and mortality, especially in the elderly age group. Delayed treatment is associated with high rates of strangulation (25-100 %). The mainstay of management for obturator hernia has been surgical. Non-operative management can lead to significant morbidity and mortality, but may be an option in patients who decline surgery, as described in our case.
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Affiliation(s)
- J J Leow
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore,
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